"; } if(isset($_POST['submit'])) { // Form has been submitted, so process it $account= $_REQUEST['actnom']; $checkval = $_REQUEST['checkval']; $patient=$_REQUEST['patient']; $auth_net_login_id = "8563ffFG4tk9"; $auth_net_tran_key = "57v778L5EXLdA6jZ"; $authnet_values = array ( "x_login" => $auth_net_login_id, "x_version" => "3.1", "x_delim_char" => "|", "x_delim_data" => "TRUE", "x_url" => "FALSE", "x_type" => "AUTH_CAPTURE", "x_method" => "CC", "x_tran_key" => $auth_net_tran_key, "x_relay_response" => "FALSE", "x_description" => "Harrington Health System Online Payment", # information collected through the form: "x_card_num" => "4242424242424242", "x_exp_date" => "1209", "x_card_code" => "", "x_amount" => "12.23", "x_first_name" => "Charles D.", "x_last_name" => "Gaulle", "x_address" => "", "x_city" => "", "x_state" => "", "x_zip" => "12345", ); // Validate information $error = ''; $mytable = "smallpaygate"; $couner = 0; $option1 = $_REQUEST['actnom']; $option1 = "'%".$option1."%'"; $option2 = "'%Approved%'"; $option3 = $_REQUEST['chgamt']; $option3a = $_REQUEST['chgamt']; if ( $option3a < $option3 ) { $option3 = "'$option3a'"; }else { $option3 = "'$option3'"; } $t=time(); $option4 = date("D F d Y "); $option4 = "'%".$option4."%'"; $option5 = "'%500001%'"; include ("/srv/include/db.inc.php"); $mytable = "smallpaygate"; $db = mysql_connect($hostname_dbConn, $username_dbConn, $password_dbConn); mysql_select_db($database_dbConn,$db); $sql = "SELECT * FROM smallpaygate where acct_num LIKE $option1 AND resp_code LIKE $option2 AND paid=$option3 AND date_time LIKE $option4 AND client_number LIKE $option5"; $results = mysql_query($sql); while ($myrow = mysql_fetch_array($results)) { $counter++; } if ( $counter > 0 ) { $error .= invalid("We apologize for the convenience but multiple payments reflecting identical dollar amounts cannot be accepted on the same account within a 24 hour period to protect our patients from misapplied charges. Please update your payment amount if a second payment is truly desired."); } if(isset($_POST['card_num']) && ctype_digit($_POST['card_num'])) $authnet_values['x_card_num'] = $_POST['card_num']; else $error .= invalid("credit card number - must be all numeric"); if(($_POST['exp_month'] != '') && ($_POST['exp_year'] != '') && read_exp_date($_POST['exp_month'].'/'.$_POST['exp_year'])) $authnet_values['x_exp_date'] = ($_POST['exp_month'].'/'.$_POST['exp_year']); else $error .= invalid("expiration date"); if(isset($_POST['card_code']) && (ctype_digit($_POST['card_code']) && (strlen($_POST['card_code']) >= 3))) $authnet_values['x_card_code'] = $_POST['card_code']; if(isset($_POST['amtpr1']) && is_money($_POST['amtpr1'])) $authnet_values['x_amount'] = $_POST['chgamt']; else $error .= invalid("amount"); if(isset($_POST['actnom']) && ($_POST['actnom'] == '')) $error .= invalid("account number"); if (( substr($_POST['actnom'], 0, 5) != "H0003") && (substr($_POST['actnom'], 0, 5) != "H0004") && (substr($_POST['actnom'], 0, 5) != "H0002") && (substr($_POST['actnom'], 0, 4) != "B000") && (substr($_POST['actnom'], 0, 5) != "H0001")) $error .= invalid("Hospital Account Numbers must be begin with H000 and are for Hospital Accounts only."); if ( strlen($_POST['actnom']) != 12 ) $error .= invalid("Invalid Hospital Account Number"); if(isset($_POST['amtpr2'])) { if ($_POST['amtpr2'] != '') { if (( substr($_POST['actnom2'], 0, 5) != "H0003") && (substr($_POST['actnom2'], 0, 5) != "H0004") && (substr($_POST['actnom2'], 0, 5) != "H0002") && (substr($_POST['actnom'], 0, 4) != "B000") && (substr($_POST['actnom'], 0, 5) != "H0001")) $error .= invalid("The second account number is an invalid Hospital Account Number."); if ( strlen($_POST['actnom2']) != 12 ) $error .= invalid("Invalid Hospital Account Number"); } } if(isset($_POST['amtpr3'])) { if ($_POST['amtpr3'] != '') { if (( substr($_POST['actnom3'], 0, 5) != "H0003") && (substr($_POST['actnom3'], 0, 5) != "H0004") && (substr($_POST['actnom3'], 0, 5) != "H0002") && (substr($_POST['actnom'], 0, 4) != "B000") && (substr($_POST['actnom'], 0, 5) != "H0001")) $error .= invalid("The third account number is an invalid Hospital Account Number."); if ( strlen($_POST['actnom3']) != 12 ) $error .= invalid("Invalid Hospital Account Number"); } } if(isset($_POST['amtpr4'])) { if ($_POST['amtpr4'] != '') { if (( substr($_POST['actnom4'], 0, 5) != "H0003") && (substr($_POST['actnom4'], 0, 5) != "H0004") && (substr($_POST['actnom4'], 0, 5) != "H0002") && (substr($_POST['actnom'], 0, 4) != "B000") && (substr($_POST['actnom'], 0, 5) != "H0001")) $error .= invalid("The fourth account number is an invalid Hospital Account Number."); if ( strlen($_POST['actnom4']) != 12 ) $error .= invalid("Invalid Hospital Account Number"); } } if(isset($_POST['amtpr5'])) { if ($_POST['amtpr5'] != '') { if (( substr($_POST['actnom5'], 0, 5) != "H0003") && (substr($_POST['actnom5'], 0, 5) != "H0004") && (substr($_POST['actnom5'], 0, 5) != "H0002") && (substr($_POST['actnom'], 0, 4) != "B000") && (substr($_POST['actnom'], 0, 5) != "H0001")) $error .= invalid("The fifth account number is an invalid Hospital Account Number."); if ( strlen($_POST['actnom5']) != 12 ) $error .= invalid("Invalid Hospital Account Number"); } } if(isset($_POST['patient']) && ($_POST['patient'] == '')) $error .= invalid("patient name"); if(isset($_POST['first_name']) && ($_POST['first_name'] != '')) $authnet_values['x_first_name'] = $_POST['first_name']; else $error .= invalid("first name"); if(isset($_POST['last_name']) && ($_POST['last_name'] != '')) $authnet_values['x_last_name'] = $_POST['last_name']; else $error .= invalid("last name"); if ( substr($_POST['card_num'], 0, 2) == "84" ) $error .= invalid("We only take Master Card and Visa"); if ( substr($_POST['card_num'], 0, 2) == "87" ) $error .= invalid("We only take Master Card and Visa"); if(isset($_POST['address']) && ($_POST['address'] != '')) $authnet_values['x_address'] = $_POST['address']; if(isset($_POST['city']) && ($_POST['city'] != '')) $authnet_values['x_city'] = $_POST['city']; if(isset($_POST['state']) && ($_POST['state'] != '')) $authnet_values['x_state'] = $_POST['state']; if(isset($_POST['zip']) && (($_POST['zip'] != '') && (strlen($_POST['zip']) == 5))) $authnet_values['x_zip'] = $_POST['zip']; if(isset($_POST['contactphone']) && (($_POST['contactphone'] != '') && (strlen($_POST['contactphone']) > 6))) $contactphone = $_POST['contactphone']; else $error .= invalid("Contact Phone - must be at least 7 digits"); if($error == '') { // form submission successfully validated, submit request to authorize.net and exit $fields = ""; foreach( $authnet_values as $key => $value ) $fields .= "$key=" . urlencode( $value ) . "&"; // * * * * * #$auth_net_url = "https://certification.authorize.net/gateway/transact.dll"; # Uncomment the line ABOVE for test accounts or BELOW for live merchant accounts #$auth_net_url = "https://secure.authorize.net/gateway/transact.dll"; # October 1, 2007 # Current API Login ID: # Current Transaction Key: $auth_net_login_id = "8563ffFG4tk9"; $auth_net_tran_key = "57v778L5EXLdA6jZ"; $ch = curl_init("https://secure.authorize.net/gateway/transact.dll"); curl_setopt($ch, CURLOPT_VERBOSE, 1); curl_setopt($ch, CURLOPT_HEADER, 0); // set to 0 to eliminate header info from response curl_setopt($ch, CURLOPT_RETURNTRANSFER, 1); // Returns response data instead of TRUE(1) curl_setopt($ch, CURLOPT_POSTFIELDS, rtrim( $fields, "& " )); // use HTTP POST to send form data curl_setopt($ch, CURLOPT_SSL_VERIFYPEER, FALSE); // uncomment this line if you get no gateway response. ### $resp = curl_exec($ch); //execute post and get results curl_close ($ch); // * * * * * $text = $resp; echo "
"; /////////////////////////////////////////////////////////// /////////////////////////////////////////////////////////// // STATISTICAL USE ONLY: // /////////////////////////////////////////////////////////// $howMany = substr_count($resp, "|"); /////////////////////////////////////////////////////////// $text = $resp; $h = substr_count($text, "|"); $h++; for($j=1; $j <= $h; $j++){ $p = strpos($text, "|"); if ($p === false) { // note: three equal signs // x_delim_char is obviously not found in the last go-around if($j>=69){ } else { } }else{ $p++; // We found the x_delim_char and accounted for it . . . now do something with it // get one portion of the response at a time $pstr = substr($text, 0, $p); // this prepares the text and returns one value of the submitted // and processed name/value pairs at a time // for AIM-specific interpretations of the responses // please consult the AIM Guide and look up // the section called Gateway Response API $pstr_trimmed = substr($pstr, 0, -1); // removes "|" at the end if($pstr_trimmed==""){ $pstr_trimmed="NO VALUE RETURNED"; } switch($j){ case 1: $fval=""; if($pstr_trimmed=="1"){ $fval="Approved"; }elseif($pstr_trimmed=="2"){ $fval="Declined"; }elseif($pstr_trimmed=="3"){ $fval="Error"; } $resp_code=$fval; break; case 2: $resp_subcode=$pstr_trimmed; break; case 3: $resp_reasoncode=$pstr_trimmed; break; case 4: $resp_text=$pstr_trimmed; break; case 5: $approval_code=$pstr_trimmed; break; case 6: break; case 7: $trans_id=$pstr_trimmed; break; case 10: $this_amount=$pstr_trimmed; break; case 14: $first_name=$pstr_trimmed; break; case 15: $last_name=$pstr_trimmed; break; case 17: //echo "Billing Address : "; //echo $pstr_trimmed; break; case 18: //echo "City : "; //echo $pstr_trimmed; break; case 19: //echo "State : "; //echo $pstr_trimmed; break; case 20: //echo "ZIP : "; //echo $pstr_trimmed; break; case 21: //echo "Country : "; //echo $pstr_trimmed; break; case 22: //echo "Phone : "; break; default: break; } // remove the part that we identified and work with the rest of the string $text = substr($text, $p); } } $acct_num1=$account; $auth_code=$approval_code; $amount=$this_amount; //$balance1=$row_RecSetPeople['balance']; $resp_code1=$resp_code; $trans_id1=$trans_id; date_default_timezone_set('America/New_York'); $t=time(); $thedate = date("D F d Y h:i:s A",$t); # if(strlen($user) <> 0) { $paytype = "C-U-".$user; } else { $paytype = "G-U"; } if ( substr($_POST['card_num'], 0, 2) == "34" ){ if(strlen($user) <> 0) { $paytype = "C-A-".$user; } else { $paytype = "G-A"; } } if ( substr($_POST['card_num'], 0, 2) == "37" ){ if(strlen($user) <> 0) { $paytype = "C-A-".$user; } else { $paytype = "G-A"; } } if ( substr($_POST['card_num'], 0, 1) == "5" ){ if(strlen($user) <> 0) { $paytype = "C-M-".$user; } else { $paytype = "G-M"; } } if ( substr($_POST['card_num'], 0, 4) == "6011" ){ if(strlen($user) <> 0) { $paytype = "C-D-".$user; } else { $paytype = "G-D"; } } if ( substr($_POST['card_num'], 0, 1) == "4" ){ if(strlen($user) <> 0) { $paytype = "C-V-".$user; } else { $paytype = "G-V"; } } if(isset($_REQUEST['amtpr1'])) { $amount = $_REQUEST['amtpr1']; $account = $_REQUEST['actnom']; $amount1 = $_REQUEST['amtpr1']; $account1 = $_REQUEST['actnom']; $Chunkspaygate = explode("|", $checkval); $shortcard = substr($_POST['card_num'], 12, 28); $mytable = "smallpaygate"; $db = mysql_connect($hostname_dbConn, $username_dbConn, $password_dbConn); mysql_select_db($database_dbConn,$db); $authnet_values['x_last_name'] = mysql_real_escape_string($authnet_values['x_last_name']); $authnet_values['x_first_name'] = mysql_real_escape_string($authnet_values['x_first_name']); $authnet_values['x_address'] = mysql_real_escape_string($authnet_values['x_address']); $authnet_values['x_city'] = mysql_real_escape_string($authnet_values['x_city']); $authnet_values['x_state'] = mysql_real_escape_string($authnet_values['x_state']); $authnet_values['x_zip'] = mysql_real_escape_string($authnet_values['x_zip']); $patient = mysql_real_escape_string($patient); $cardholdname = $authnet_values['x_first_name']." ".$authnet_values['x_last_name']; $contactphone = mysql_real_escape_string($contactphone); $shortcard = mysql_real_escape_string($shortcard); $cardholdaddr = $authnet_values['x_address']; $cardholdcity = $authnet_values['x_city']; $cardholdstate = $authnet_values['x_state']; $cardholdzip = $authnet_values['x_zip']; $account = mysql_real_escape_string($account); $amount = mysql_real_escape_string($amount); if(strlen($user) <> 0) { $userout = "Online"; } $location = "Faculty"; $locationumber = substr($account, 0, 1); if ( $locationumber == "F" ) { $location = "Fairview"; } if ( $locationumber == "M" ) { $location = "Berkshire"; } if ( $locationumber == "B" ) { $location = "Fairview"; } if ( $locationumber == "m" ) { $location = "Berkshire"; } if ( $locationumber == "b" ) { $location = "Fairview"; } if ( $locationumber == "f" ) { $location = "Fairview"; } $query = "INSERT INTO $mytable (acct_num,auth_code,paid,resp_code,trans_id,date_time,transtype,location,cardholdername,cardholderaddress,cardholdercity,cardholderstate,cardholderzip,cardnumber,patientname,phonenumber,client_number,user) VALUES ('$account', '$auth_code', '$amount', '$resp_code1', '$trans_id1', '$thedate', '$paytype', '$location', '$cardholdname', '$cardholdaddr', '$cardholdcity', '$cardholdstate', '$cardholdzip', '$shortcard', '$patient', '$contactphone', '500001', '$userout' )"; mysql_query($query,$db); mysql_close ($db); } $amount = $_REQUEST['amtpr2']; $account = $_REQUEST['actnom2']; $amount2 = $_REQUEST['amtpr2']; $account2 = $_REQUEST['actnom2']; if ( $amount > 0 ) { $db = mysql_connect($hostname_dbConn, $username_dbConn, $password_dbConn); mysql_select_db($database_dbConn,$db); $authnet_values['x_last_name'] = mysql_real_escape_string($authnet_values['x_last_name']); $authnet_values['x_first_name'] = mysql_real_escape_string($authnet_values['x_first_name']); $authnet_values['x_address'] = mysql_real_escape_string($authnet_values['x_address']); $authnet_values['x_city'] = mysql_real_escape_string($authnet_values['x_city']); $authnet_values['x_state'] = mysql_real_escape_string($authnet_values['x_state']); $authnet_values['x_zip'] = mysql_real_escape_string($authnet_values['x_zip']); $patient = mysql_real_escape_string($patient); $cardholdname = $authnet_values['x_first_name']." ".$authnet_values['x_last_name']; $contactphone = mysql_real_escape_string($contactphone); $shortcard = mysql_real_escape_string($shortcard); $cardholdaddr = $authnet_values['x_address']; $cardholdcity = $authnet_values['x_city']; $cardholdstate = $authnet_values['x_state']; $cardholdzip = $authnet_values['x_zip']; $account = mysql_real_escape_string($account); $amount = mysql_real_escape_string($amount); if(strlen($user) <> 0) { $userout = "Online"; } $location = "Faculty"; $locationumber = substr($account, 0, 1); if ( $locationumber == "F" ) { $location = "Fairview"; } if ( $locationumber == "M" ) { $location = "Berkshire"; } if ( $locationumber == "B" ) { $location = "Fairview"; } if ( $locationumber == "m" ) { $location = "Berkshire"; } if ( $locationumber == "b" ) { $location = "Fairview"; } if ( $locationumber == "f" ) { $location = "Fairview"; } $query = "INSERT INTO $mytable (acct_num,auth_code,paid,resp_code,trans_id,date_time,transtype,location,cardholdername,cardholderaddress,cardholdercity,cardholderstate,cardholderzip,cardnumber,patientname,phonenumber,client_number,user) VALUES ('$account', '$auth_code', '$amount', '$resp_code1', '$trans_id1', '$thedate', '$paytype', '$location', '$cardholdname', '$cardholdaddr', '$cardholdcity', '$cardholdstate', '$cardholdzip', '$shortcard', '$patient', '$contactphone', '500001', '$userout' )"; mysql_query($query,$db); mysql_close ($db); } $amount = $_REQUEST['amtpr3']; $account = $_REQUEST['actnom3']; $amount3 = $_REQUEST['amtpr3']; $account3 = $_REQUEST['actnom3']; if ( $amount > 0 ) { $db = mysql_connect($hostname_dbConn, $username_dbConn, $password_dbConn); mysql_select_db($database_dbConn,$db); $authnet_values['x_last_name'] = mysql_real_escape_string($authnet_values['x_last_name']); $authnet_values['x_first_name'] = mysql_real_escape_string($authnet_values['x_first_name']); $authnet_values['x_address'] = mysql_real_escape_string($authnet_values['x_address']); $authnet_values['x_city'] = mysql_real_escape_string($authnet_values['x_city']); $authnet_values['x_state'] = mysql_real_escape_string($authnet_values['x_state']); $authnet_values['x_zip'] = mysql_real_escape_string($authnet_values['x_zip']); $patient = mysql_real_escape_string($patient); $cardholdname = $authnet_values['x_first_name']." ".$authnet_values['x_last_name']; $contactphone = mysql_real_escape_string($contactphone); $shortcard = mysql_real_escape_string($shortcard); $cardholdaddr = $authnet_values['x_address']; $cardholdcity = $authnet_values['x_city']; $cardholdstate = $authnet_values['x_state']; $cardholdzip = $authnet_values['x_zip']; $account = mysql_real_escape_string($account); $amount = mysql_real_escape_string($amount); if(strlen($user) <> 0) { $userout = "Online"; } $location = "Faculty"; $locationumber = substr($account, 0, 1); if ( $locationumber == "F" ) { $location = "Fairview"; } if ( $locationumber == "M" ) { $location = "Berkshire"; } if ( $locationumber == "B" ) { $location = "Fairview"; } if ( $locationumber == "m" ) { $location = "Berkshire"; } if ( $locationumber == "b" ) { $location = "Fairview"; } if ( $locationumber == "f" ) { $location = "Fairview"; } $query = "INSERT INTO $mytable (acct_num,auth_code,paid,resp_code,trans_id,date_time,transtype,location,cardholdername,cardholderaddress,cardholdercity,cardholderstate,cardholderzip,cardnumber,patientname,phonenumber,client_number,user) VALUES ('$account', '$auth_code', '$amount', '$resp_code1', '$trans_id1', '$thedate', '$paytype', '$location', '$cardholdname', '$cardholdaddr', '$cardholdcity', '$cardholdstate', '$cardholdzip', '$shortcard', '$patient', '$contactphone', '500001', '$userout' )"; mysql_query($query,$db); mysql_close ($db); } $amount = $_REQUEST['amtpr4']; $account = $_REQUEST['actnom4']; $amount4 = $_REQUEST['amtpr4']; $account4 = $_REQUEST['actnom4']; if ( $amount > 0 ) { $db = mysql_connect($hostname_dbConn, $username_dbConn, $password_dbConn); mysql_select_db($database_dbConn,$db); $authnet_values['x_last_name'] = mysql_real_escape_string($authnet_values['x_last_name']); $authnet_values['x_first_name'] = mysql_real_escape_string($authnet_values['x_first_name']); $authnet_values['x_address'] = mysql_real_escape_string($authnet_values['x_address']); $authnet_values['x_city'] = mysql_real_escape_string($authnet_values['x_city']); $authnet_values['x_state'] = mysql_real_escape_string($authnet_values['x_state']); $authnet_values['x_zip'] = mysql_real_escape_string($authnet_values['x_zip']); $patient = mysql_real_escape_string($patient); $cardholdname = $authnet_values['x_first_name']." ".$authnet_values['x_last_name']; $contactphone = mysql_real_escape_string($contactphone); $shortcard = mysql_real_escape_string($shortcard); $cardholdaddr = $authnet_values['x_address']; $cardholdcity = $authnet_values['x_city']; $cardholdstate = $authnet_values['x_state']; $cardholdzip = $authnet_values['x_zip']; $account = mysql_real_escape_string($account); $amount = mysql_real_escape_string($amount); if(strlen($user) <> 0) { $userout = "Online"; } $location = "Faculty"; $locationumber = substr($account, 0, 1); if ( $locationumber == "F" ) { $location = "Fairview"; } if ( $locationumber == "M" ) { $location = "Berkshire"; } if ( $locationumber == "B" ) { $location = "Fairview"; } if ( $locationumber == "m" ) { $location = "Berkshire"; } if ( $locationumber == "b" ) { $location = "Fairview"; } if ( $locationumber == "f" ) { $location = "Fairview"; } $query = "INSERT INTO $mytable (acct_num,auth_code,paid,resp_code,trans_id,date_time,transtype,location,cardholdername,cardholderaddress,cardholdercity,cardholderstate,cardholderzip,cardnumber,patientname,phonenumber,client_number,user) VALUES ('$account', '$auth_code', '$amount', '$resp_code1', '$trans_id1', '$thedate', '$paytype', '$location', '$cardholdname', '$cardholdaddr', '$cardholdcity', '$cardholdstate', '$cardholdzip', '$shortcard', '$patient', '$contactphone', '500001', '$userout' )"; mysql_query($query,$db); mysql_close ($db); } $amount = $_REQUEST['amtpr5']; $account = $_REQUEST['actnom5']; $amount5 = $_REQUEST['amtpr5']; $account5 = $_REQUEST['actnom5']; if ( $amount > 0 ) { $db = mysql_connect($hostname_dbConn, $username_dbConn, $password_dbConn); mysql_select_db($database_dbConn,$db); $authnet_values['x_last_name'] = mysql_real_escape_string($authnet_values['x_last_name']); $authnet_values['x_first_name'] = mysql_real_escape_string($authnet_values['x_first_name']); $authnet_values['x_address'] = mysql_real_escape_string($authnet_values['x_address']); $authnet_values['x_city'] = mysql_real_escape_string($authnet_values['x_city']); $authnet_values['x_state'] = mysql_real_escape_string($authnet_values['x_state']); $authnet_values['x_zip'] = mysql_real_escape_string($authnet_values['x_zip']); $patient = mysql_real_escape_string($patient); $cardholdname = $authnet_values['x_first_name']." ".$authnet_values['x_last_name']; $contactphone = mysql_real_escape_string($contactphone); $shortcard = mysql_real_escape_string($shortcard); $cardholdaddr = $authnet_values['x_address']; $cardholdcity = $authnet_values['x_city']; $cardholdstate = $authnet_values['x_state']; $cardholdzip = $authnet_values['x_zip']; $account = mysql_real_escape_string($account); $amount = mysql_real_escape_string($amount); if(strlen($user) <> 0) { $userout = "Online"; } $location = "Faculty"; $locationumber = substr($account, 0, 1); if ( $locationumber == "F" ) { $location = "Fairview"; } if ( $locationumber == "M" ) { $location = "Berkshire"; } if ( $locationumber == "B" ) { $location = "Fairview"; } if ( $locationumber == "m" ) { $location = "Berkshire"; } if ( $locationumber == "b" ) { $location = "Fairview"; } if ( $locationumber == "f" ) { $location = "Fairview"; } $query = "INSERT INTO $mytable (acct_num,auth_code,paid,resp_code,trans_id,date_time,transtype,location,cardholdername,cardholderaddress,cardholdercity,cardholderstate,cardholderzip,cardnumber,patientname,phonenumber,client_number,user) VALUES ('$account', '$auth_code', '$amount', '$resp_code1', '$trans_id1', '$thedate', '$paytype', '$location', '$cardholdname', '$cardholdaddr', '$cardholdcity', '$cardholdstate', '$cardholdzip', '$shortcard', '$patient', '$contactphone', '500001', '$userout' )"; mysql_query($query,$db); mysql_close ($db); } # # if ( $resp_code == "Approved" ){ $shortcard = substr($_POST['card_num'], 10, 28); ?>
Invoice Information
Billing Information
|
Credit Card Declined
Your Credit Card was declined. The following reason was given: Amount
#"; echo "
- $error
« go back"; $continue = "n"; ?>
AT LEAST ONE ACCOUNT HAS TO BE SELECTED FOR PAYMENT. PLEASE USE THE BACK ARROW OF YOUR BROWSER. THANK YOU! Please note: If you are paying for more than one visit at Harrington Health Systems you must list each visit separately, using the appropriate account number and the amount you are paying on each account.Required fields are marked with an (*).